Di Shi

The rising comorbidity of myopia and overweight/obesity (OWOB) in children shares modifiable behavioral pathways, yet evidence for integrated prevention remains limited. We conducted a cluster‐randomized, hybrid type I effectiveness‐implementation trial in 36 pair‐matched Beijing schools. Of 4991 enrolled students in Grades 1–4 and 7, 3426 (68.6%) completed the 12‐month follow‐up. The school‐centered “22510SS” intervention targeted outdoor activity, screen time, diet, sleep, and health monitoring. No statistically significant between‐group differences were observed in spherical equivalent or BMI change, or in the prevalence of myopia, OWOB, or their comorbidity. The intervention improved the overall behavior‐improvement rate (39.7% vs. 33.7%; OR, 1.34; 95% CI, 1.00–1.80). In a prespecified analysis, students in Grades 1–4 showed slower myopia progression (OR, 0.46; 95% CI, 0.25–0.86); an exploratory analysis suggested benefits among children from less supportive family environments. Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE‐AIM) evaluation showed 100% fidelity for school‐based activities, approximately 60% completion of family‐facing health‐tip dissemination, an incremental cost of ¥215.43 per participant, and a Program Sustainability Assessment Tool (PSAT) score of 6.10/7. The intervention was feasible and improved targeted behaviors but did not produce significant population‐level clinical effects within 12 months. Stronger family engagement and longer follow‐up may be needed. Trial Registration: NCT05275959

Systematic investigations of biological development trajectories among ethnic minority adolescent populations are crucial for advancing health equity within the context of the Sustainable Development Goals [1,2]. Age at menarche (AAM) is a widely used marker of female pubertal development and is associated with socioeconomic, nutritional, environmental, and broader ecological conditions [3,4]. Long-term declines in AAM […]

Background: Early puberty has been associated with various adverse health outcomes. We aimed to characterize the spatiotemporal patterns of age at menarche or spermarche in China and to identify potential associated factors. Methods: We leveraged data from six consecutive nation-wide cross-sectional surveys in China conducted in 1995, 2000, 2005, 2010, 2014, and 2019. A total of 519 940 girls aged 9 to 18 years and 392 813 boys aged 11 to 18 years from 30 provinces in Mainland China were included. Probabilistic analysis was used to estimate the median ages at spermarche or menarche as surrogate measures of pubertal development. We used Bayesian spatiotemporally varying series models with the spatiotemporal variance partitioning index to assess the spatiotemporal heterogeneity of ages at menarche or spermarche across 30 provinces and to quantify the relative contributions of the socioeconomic and environmental factors. Results: Almost all provinces experienced decreases in the median ages at spermarche and menarche during the study period. Regional disparities were identified, as a faster decreasing trend was generally observed in eastern provinces when compared with western provinces. Socioeconomic factors explained 34.58% of the spatiotemporal heterogeneity for boys and 34.17% for girls, while environmental factors explained 55.68 and 56.22%, respectively. Among these, temperature, nighttime light, nitrogen dioxide, relative humidity, and illiteracy rate showed the largest contributions (each >5%). In general, higher levels of economic indicators and environmental stressors were observed in provinces with lower initial ages at spermarche and menarche and/or faster declining trends. Conclusions: A significant trend toward early puberty was observed in China over the past 25 years, especially in eastern provinces. Both socioeconomic and environmental factors were strongly associated with the observed spatiotemporal patterns.

Despite spending a substantial proportion of their time indoors, the mental health effects of indoor air pollution on children and adolescents remain inadequately explored. This study aimed to elucidate the spatiotemporal variations and sociodemographic inequalities in exposure to multiple indoor pollutants and to assess their potential associations with depressive symptoms among school-aged children in Beijing. Using real-time portable monitors, concentrations of fine particulate matter (PM_2.5), coarse particulate matter (PM₁₀), carbon dioxide (CO₂), formaldehyde (HCHO), total volatile organic compounds (TVOC), temperature, and humidity in classrooms and bedrooms were measured during both weekdays and weekends. Moreover, substantial spatiotemporal heterogeneity was observed. It was found that concentrations of PM_2.5, PM₁₀, and TVOC peaked in classrooms during weekday daytime, while CO₂ levels were highest in bedrooms on weekend nights. Exposure levels were notably higher among children whose mothers had lower educational attainment and those living in recently renovated homes, indicating marked socio-demographic disparities. In multivariable logistic regression models, indoor exposure to CO₂ and TVOC was significantly associated with increased odds of depressive symptoms. These findings highlight the critical need to improve indoor air quality through enhanced ventilation and the mitigation of emissions from indoor sources, particularly within school and residential settings. The results offer valuable empirical evidence to guide the development of targeted environmental interventions and public health policies designed to support and enhance the psychological well-being of children.

Pubertal development influences not only the current health of children and adolescents, but also their physical and mental health in adulthood, and the health of the next generation [1]. Many countries have discovered that the puberty occurred earlier and earlier in both sexes [2], especially for girls, with disparities between urban and rural areas. Early […]

Objective: To describe the secular trends of cause-specific mortality among adolescents aged 10 to 24 years from 2004 to 2019 and explore the association between mortality and economic status, education level as well as health investment. Methods: Mortality data of adolescents aged 10 to 24 years were obtained from the national disease surveillance points system. The age-standardized mortality rate (ASMR) was calculated by using the population data from the sixth national population census in 2010. GDP per capita, urbanization rate, illiteracy rate of the population over 15 years old, government education expenditure per capita, number of health service providers per 1000 people, and number of health beds per 1000 people were collected from China’s Economic and Social Big Data Research Platform. Age-period-cohort analysis was used to analyse the net age, period, and cohort effects of mortality among adolescents, while panel data regression was used to explore the association between mortality and economic status, education level as well as health investment. Results: Overall, the ASMR was 28.84 per 100,000 and the top five causes of mortality were road injuries, drowning, intentional self-harm and sequelae, leukaemia, and falls among adolescents aged 10 to 24 years in China in 2019. All-cause mortality declined with an annual percentage change of 4.02% (95% Confidence interval: 3.74% to 4.30%) from 2004 to 2019 yet with persistent differences across different demographic (gender and age) and geographical (urban-rural, and regional) subgroups. Notably, the ASMR for HIV/AIDS in males, lower respiratory infections in urban adolescents, and iron deficiency anaemia as well as cervical cancer in adolescents aged 20 to 24 years showed an increase over time. The multivariate panel data regression showed that the ASMR decreased by 5.18 (3.27, 7.08) per 100,000 for every increase in the number of health beds per 1000 population, but with insignificant association with GDP per capita and illiteracy rate in the total sample. Health beds investment was positively associated with ASMR at almost all subgroups except for adolescents aged 10 to 14 years; GDP per capita increase was helpful to males and rural adolescents while an increasing literacy rate was beneficial for females and adolescents aged 15 to 19 years. Conclusion: Given the persistent differences between subgroups, further investments including improving health services, especially increasing health bed investment, GDP per capita, and reducing the illiteracy rate and concern for adolescents in males, rural areas, the western regions, and aged 15 to 24 years are needed. Additionally, the increased burden of some diseases, such as HIV/AIDS, must be of further concern.

Background: Evidence in adults suggests that exposure to artificial light-at-night (ALAN) leads to obesity. However, little is known about whether this effect exists in children and adolescents. We aimed to investigate whether ALAN exposure was associated with overweight and obesity in school-aged children and adolescents and whether this association varied with socioeconomic status. Methods: Data on the height and weight of 129,500 children and adolescents aged 10–18 years from 72 cities were extracted from the 2014 Chinese National Survey on Students’ Constitution and Health (CNSSCH). The ALAN area percentage and average ALAN intensity were calculated using the Visible/Infrared Imager/Radiometer Suite. The subjects were separated into three categories based on the cities’ gross domestic product per capita (GDPPC). A mixed-effect logistic regression model and generalized additive model (GAM) were utilized to evaluate the association between ALAN exposure and overweight and obesity in children and adolescents stratified by municipal GDPPC. Results: Both ALAN area (OR = 1.194, 95% CI: 1.175–1.212) and ALAN intensity (OR = 1.019, 95% CI: 1.017–1.020) were positively associated with overweight and obesity in children and adolescents, and the associations remained robust after adjusting for covariates. ORs for overweight and obesity and ALAN area decreased as GDPPC level increased (first tertile: OR = 1.457, 95% CI: 1.335–1.590; second tertile: OR = 1.350, 95% CI: 1.245–1.464; third tertile: OR = 1.100, 95% CI: 1.081–1.119). Similar results were observed for ALAN intensity. In the GAM models, thresholds existed in almost all these spline trends, indicating that ALAN might have a nonlinear association with overweight and obesity. Conclusions: ALAN contributed to the development of overweight and obesity in children and adolescents and this effect differed with GDPPC. Future longitudinal studies should confirm the causal relationship between ALAN and obesity. Moreover, reducing unnecessary exposure to artificial light at night may have beneficial implications for controlling childhood and adolescent obesity, particularly in low-income areas.

Aim: To examine the secular trend and the urban-rural disparity of spermarche among Chinese Han boys from 1995 to 2019. Methods: A total of 392 775 boys of Han ethnicity aged 11-18 years were extracted from the 1995, 2000, 2005, 2010, 2014 and 2019 Chinese National Surveys on Students' Constitution and Health. The median age at spermarche was estimated using the status quo data and probit analysis. The chi-square, ANOVA and LSD tests were used to compare the differences between the year-subgroups. U-test was used to compare the difference between urban and rural areas at each year. Results: The median age at spermarche in Chinese Han boys decreased from 14.6 years in 1995 to 13.9 years in 2019 (p < 0.001). The rural boys showed a faster decreasing pace with a 1-year advance of age at spermarche while the urban boys had only a 0.5-year decrement, and there was still a statistically significant difference between urban-rural areas in 2019 (p < 0.001). Similar to urban-rural disparity, the age gap at spermarche between areas with different urbanisation rates became smaller over time. Conclusions: In general, spermarche in Chinese Han boys showed a decreasing trend, but the pace was slowing down. The urban-rural disparity in puberty development still existed but was gradually narrowing.

Background: Due to the adverse effects of cardio-metabolic risk factors (CMRFs) in children and adolescents on their current and later life health, and the growing evidence that birth weight and lifestyle have on CMRFs, we aimed to estimate the combined effect of birth weight and lifestyle on clustered CMRFs in children and adolescents. Methods: We enrolled 11,509 participants aged 7–18 years old in a national school-based cross-sectional study in seven provinces in China in 2013. Information on CMRFs was collected through anthropometric measurements and blood sample testing. Information on birth weight, lifestyle and other basic information were investigated through children and adolescents’ as well as parents’ questionnaires. The generalized linear mixed model was applied to estimate the odd ratio (OR) and 95% confidence interval (95% CI) for the associations between CMRFs, clustered CMRFs and birth weight, lifestyle, and the combinations of birth weight and lifestyle. Results: Overall, the prevalence of clustered CMRFs was 3.6% in children and adolescents aged 7–18 years, higher in boys (4.4%) than girls (2.9%). The combination of LBW/ideal lifestyle (OR = 2.00, 95% CI: 1.07–3.72) was associated with higher risk of clustered CMRFs, as well as in adolescents aged 13–18 years and in boys. The combination of HBW/poor lifestyle (OR = 1.74, 95% CI: 1.13–2.68) was related to elevated risk of clustered CMRFs, especially in children aged 7–12 years. Conclusions: CMRFs in Chinese children and adolescents is concerning, ideal lifestyle could weaken the association of birth weight with clustered CMRFs, especially in younger age, indicating that programs to prevent abnormal birth weight or poor lifestyle or both among children and adolescents may reduce CMRFs in China.